Disposal of Unused Medicines: What You Should Know

DEA Drug Take Back: April 28, 2018
When your medicines are no longer needed, they should be disposed of promptly. Consumers and caregivers should remove expired, unwanted, or unused medicines from their home as quickly as possible to help reduce the chance that others accidentally take or intentionally misuse the unneeded medicine, and to help reduce drugs from entering the environment. Below, we list some options and special instructions for you to consider when disposing of expired, unwanted, or unused medicines.

Your best choices for disposal of unused or expired medicines are:

Medicine take-back options,
Disposal in the household trash and
Flushing certain potentially dangerous medicines in the toilet
More information on each of these options is available below.
Contents
Learn more about:

How to dispose of unused/expired medicine
Medicine take-back options
Disposal in the household trash
Flushing certain potentially dangerous medicines in the toilet
Impact of flushing medicines on the environment
List of medicines recommended for disposal by flushing
Medication disposal questions and answers
How to dispose of unused/expired medicine

Medicine take-back options

This graphic visually depicts the methods available to consumers to dispose of their unused, unwanted or expired medications. The methods, in order of preference, include readily available drug take-bake programs, disposal in the household trash and, for a few potentially dangerous medications, disposal by flushing in the toilet.
Drug Disposal Options Infographic (PDF-2.1MB)
Consumers and caregivers should remove expired or unused medicines from their home as quickly as possible to help reduce the chance that others may accidentally take or intentionally misuse the unneeded medicine.
Medicine take-back options are the preferred way to safely dispose of most types of unneeded medicines. There are generally two kinds of take-back options: periodic events and permanent collection sites.

Periodic events

The U.S. Drug Enforcement Administration (DEA) periodically hosts National Prescription Drug Take-Back events where temporary collection sites are set up in communities nationwide for safe disposal of prescription drugs. It should be noted, however, that a small number of medicines have specific directions to immediately flush them down the toilet when they are no longer needed and a take-back option is not readily available.
Local law enforcement agencies may also sponsor medicine take-back events in your community. Consumers can also contact their local waste management authorities to learn about events in their area.

Permanent collection sites

Another option for consumers and long-term care facilities to dispose of unneeded medicines is to transfer these medicines to DEA-registered collectors, which safely and securely collect and dispose of pharmaceuticals containing controlled substances and other medicines.
In your community, authorized permanent collection sites may be in retail pharmacies, hospital or clinic pharmacies, and law enforcement facilities. Some authorized collection sites may also offer mail-back programs or collection receptacles, sometimes called “drop-boxes,” to assist consumers in safely disposing of their unused medicines.

Consumers can visit the DEA’s website for more information about drug disposal, National Prescription Drug Take-Back Day events and to locate a DEA-registered collector in their area. Consumers may also call the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539 to find an authorized collector in their community.
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Disposal in the household trash

Disposal Instructions Graphic
If no take-back programs or DEA-registered collectors are available in your area, and there are no specific disposal instructions in the product package insert, such as flushing described below, you can also follow these simple steps to dispose of most medicines in the household trash*:

Mix medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, cat litter, or used coffee grounds;
Place the mixture in a container such as a sealed plastic bag;
Throw the container in your household trash; and
Delete all personal information on the prescription label of empty pill bottles or medicine packaging, then dispose of the container.
*Other technologies to provide additional options for patients to use to dispose of medicines in the household trash have been developed.
Flushing certain potentially dangerous medicines in the toilet

A small number of medicines have specific instructions to immediately flush down the toilet when no longer needed and a take-back option is not readily available. These medicines may be especially harmful and, in some cases, fatal with just one dose if they are used by someone other than the person for whom they were prescribed. But as drug take-back programs and sites increase across the country, these could be options too, if one is readily available to you.
Promptly disposing of unneeded medications can help prevent accidental exposure to, including ingestion of, these potentially dangerous medicines by children and others, including pets.

There are some medicines that, when not disposed of properly, can pose significant risks. For example, patients using fentanyl patches should immediately flush their used or unneeded patches down the toilet. When powerful medicines such as these patches are disposed down the toilet, you help to keep others safe by ensuring these medicines are not misused or accidentally ingested or touched.

Some medicines come with disposal instructions. If you received disposal instructions for a medicine, you should dispose of that medicine as directed by those instructions. Otherwise, if your medicine is on the list of medicines recommended for flushing, and you did not receive information containing disposal instructions along with your prescription, you should dispose of any used or unneeded medicine by flushing it down the toilet if a take-back option is not readily available.

For additional information, see Medication Disposal: Questions and Answers.

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Drug Disposal Warning

Impact of flushing medicines on the environment

FDA recognizes that the recommendation to flush certain potentially dangerous medicines when a take-back option is not readily available raises questions about their impact on the environment and contamination of surface and drinking water supplies. In an effort to address this concern, FDA staff published a paper entitled “Risks Associated with the Environmental Release of Pharmaceuticals on the U.S. Food and Drug Administration ‘Flush List’.”
This paper evaluates the environmental and human health risks associated with the flushing of 15 medicines. FDA concluded that these medicines present negligible risk to the environment, although some additional data would be helpful for confirming this finding for some of these medicines.

FDA believes that the known risk of harm, including death, to humans from accidental exposure to certain medicines, especially potent opioid medicines, far outweighs any potential risk to humans or the environment from flushing these medicines when a take-back option is not readily available. FDA will continue to conduct risk assessments as a part of our larger activities related to the safe use of medicines.

List of medicines recommended for disposal by flushing when take-back options are not readily available

This list from FDA tells you which medicines you should flush when they are no longer needed and take-back options are not readily available. Links in the list below direct you to medicine information for consumers that includes specific disposal instructions.
For disposal information specific to other medications you are taking, please visit Drugs@FDA. Once there, type in the medication name and click on search. Then click on the label section for that specific medication. Select the most recent label and search for the term “disposal.”

What are FDA’s recommendations for removing unused medicines from the home?
Why do the medicines on this list have directions for disposal by flushing and other medicines do not? What is the rationale for this policy?
How big of a problem is accidental pediatric exposure to medicine in the United States?
Does flushing the medicines on this list down the toilet pose a risk to human health or the environment? How have considerations about medicines in the environment informed FDA’s recommendations about the disposal of medicines from the home?
Can the medicines that FDA recommends for disposal by flushing be eliminated from the home in some other manner; for example, by drug-take back programs or returning the medicine to the pharmacy?
‘I live in an assisted living community and take my own medicines’ or ‘My family member was in hospice and has since passed away.’ How can I safely dispose of medicines that are no longer needed?
Can unused/unexpired medications be donated?
How do I dispose of dietary supplements and over the counter (OTC) drugs?
Does FDA have a pamphlet on drug disposal I can print and hand out?
What are FDA’s recommendations for removing unused medicines from the home?

FDA supports the responsible disposal of medicines from the home. Almost all medicines can be safely disposed of by using medicine take-back programs or using U.S. Drug Enforcement Administration (DEA)-authorized collectors. When these options are not available, consumers may also dispose of most unneeded medicine in their household trash.

DEA-authorized collectors safely and securely collect and dispose of pharmaceutical controlled substances and other prescription drugs. In your community, authorized collection sites may be retail pharmacies, hospital or clinic pharmacies, and law enforcement locations. Some pharmacies may also offer mail-back envelopes to assist consumers in safely disposing of their unused medicines through the U.S. mail.

Consumers can visit the DEA’s website for more information about drug disposal and to locate an authorized collector in their area. Consumers may also call the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539 to find an authorized collector in their community. Local law enforcement agencies may also sponsor medicine take-back programs in your community. Contact your city or county government for more information on local drug take-back programs. The DEA periodically hosts National Prescription Drug Take-Back events where collection sites are set up in communities nationwide for safe disposal of prescription drugs.

If a take-back or mail back program is not readily available to you, most other unused or expired medicines can be disposed of in your household trash. First, mix the medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, cat litter, or used coffee grounds. Then place the mixture in a container such as a zip-top or sealable plastic bag, and throw the container away in your household trash. Before throwing out your empty pill bottle or other empty medicine packaging remember to scratch out all personal information on the prescription label to make it unreadable.

There are, however, a few prescription medicines that contain controlled substances and are especially harmful if taken accidentally by someone other than the patient. These medicines should not be thrown in the trash, because this method may still provide an opportunity for a child or pet to accidentally take the medicine. If a DEA-authorized collector or drug take-back program is not available, FDA recommends that these medicines be disposed of by flushing when they are no longer needed and take-back options are not readily available. The list of medicines recommended for disposal by flushing can be seen at in this table.

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Why do the medicines on this list have directions for disposal by flushing when take-back options are not readily available, while and other medicines do not? What is the rationale for this policy?

The medicines recommended for disposal by flushing are safe and effective when used as prescribed, but they could be especially harmful to a child, pet, or others if taken accidentally. Some of the possible harmful effects include breathing difficulties or heart problems, which could lead to death. For these reasons, FDA recommends that when it isn’t possible to return these medicines through a take-back program or to a DEA-authorized collector via a collection box or mail-back program, consumers should flush them down the toilet to immediately and permanently remove this risk from their home.

Reducing the risk of harm from accidental exposure to this small, select list of medicines is of utmost concern to FDA and we believe that this risk far outweighs any potential risk to human health or the environment that may come from disposal by flushing. FDA continues to work with and encourage manufacturers of these medicines to develop alternative, safe disposal systems.

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How big of a problem is accidental pediatric exposure to medicine in the United States?

Accidental exposure to medicine in the home is a major source of unintentional pediatric poisonings in the United States. Each year in the United States, approximately 60,000 emergency department (ED) visits [1,2] and 450,000 calls to poison centers [3] are made after children under 6 years of age find and ingest medication without caregiver oversight. Over two-thirds of ED visits for accidental pediatric medication exposures involve 1- or 2- year old children and nearly 20% result in hospitalization [1].

Keeping medicines after they are no longer needed creates an unnecessary health risk in the home, especially if there are children present. Even child resistant containers cannot completely prevent a child from taking medicines that belong to someone else. In a study that looked at cases of accidental child exposure to a grandparent’s medicine, 45% of cases involved medicines stored in child-resistant containers.

Cases of inadvertent exposure to some of these medicines were published in the American Association of Poison Control Centers’ 2016 annual report [3]. Below are two case summaries to illustrate how some medicines can result in death if they are accidentally taken by children.

A 2 year old female was seen drinking an unknown liquid from a stray plastic bottle. The next day she was lethargic, later that day her parents found her unresponsive with labored breathing, and transported her to the emergency department (ED). The child arrived to the ED in cardiac arrest, pupils were fixed and dilated. Laboratory/diagnostic findings: Urine drug screen (UDS) was positive for methadone. Head CT was consistent with anoxic brain injury. She was determined to be brain dead after a 10 day clinical course.
A 15 month old female was found with a buprenorphine/naloxone film wrapper in her mouth. Her mother removed it and took her to the ED where she remained asymptomatic for 4 hours. A UDS was negative for opiates and she was discharged. She was found at home, 5 hours later, in cardiac arrest. EMS began CPR and transported to the ED. In the ED, she was intubated and received naloxone and epinephrine. CPR was continued for 1 hour, but she died.
References:

Lovegrove MC, Weidle NJ, Budnitz DS. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013. Pediatrics. 2015;136(4):e821-829.
Centers for Disease Control and Prevention. PROTECT Initiative: Advancing Children’s Medication Safety. https://www.cdc.gov/medicationsafety/protect/protect_initiative.html
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017;55(10):1072-1252.
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Does flushing the medicines on this list down the toilet pose a risk to human health or the environment? How have considerations about medicines in the environment informed FDA’s recommendations about the disposal of medicines from the home?

FDA is aware of reports of very low, but measurable levels of medicines in surface waters such as rivers and streams, and to a lesser extent in drinking water. Disposal of these select few medicines by flushing, when take-back options are not readily available, would contribute only a small fraction of the total amount of medicine found in our surface and drinking water. The majority of medicines found in water are a result of the body’s natural routes of drug elimination (in urine or feces).

Based on the available data, FDA believes that the known risk of harm to humans from accidental exposure to these medicines far outweighs any potential risk to humans or the environment from flushing them.

To date, scientists have found no evidence of harmful effects to human health from medicines in the environment. In addition, to better understand the human health and ecological risks from medicines in our water, FDA works with other agencies, including the U.S. Environmental Protection Agency (EPA). Still, to reduce overall medicine levels in our waters, FDA recommends that if readily available, consumers first consider disposing of these drugs as quickly as possible through medicine take-back programs or DEA-authorized collectors before flushing down the toilet.

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Can the medicines that FDA recommends for disposal by flushing be eliminated from the home in some other manner; for example, by drug-take back programs or returning the medicine to the pharmacy?

Yes, almost all the medicines. FDA recommends for disposal by flushing should be disposed of through take-back options if readily available. For example, consumers can return these medicines to a DEA-authorized collector through secure collection receptacles or mail-back packages, and to local and national medicine take-back programs. Authorized collection sites may be retail pharmacies, hospital or clinic pharmacies, and law enforcement locations. However, since these medicines may be especially harmful to a child, pet, or anyone else if taken accidentally, it is important to store them safely and securely until disposal.

Your local law enforcement agency may sponsor drug take-back events that can accept medicines containing controlled substances. If there is not a timely take-back program in your area that accepts medicines containing controlled substances, the most effective way to immediately and completely eliminate the potential for harm is to remove these medicines from the home by flushing them down the toilet.

To find out whether there are alternative disposal options for medicines containing controlled substances in your community, contact your city or county government. Consumers can visit the DEA’s website for more information about drug disposal, National Prescription Drug Take-Back Day events and to locate a DEA-authorized collector in their area. Consumers may also call the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539 to find an authorized collector in their community, or talk to their pharmacist to see if he or she knows of other disposal programs in your area.

FDA continues to work with and encourage the manufacturers of these products to develop alternative, safe disposal systems.

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‘I live in an assisted living community and take my own medicines’ or ‘My family member was in hospice and has since passed away.’ How can I safely dispose of medicines that are no longer needed?

Check first with your community’s health care management team or hospice contact to learn the best way to dispose of used or unneeded medicines. If you learn that you are responsible for disposal of unneeded medicines, follow the directions above regarding disposal options.

It is important to remember that the preferred method of disposal is medicine take-back options. But if these options are not readily available, many medicines can be disposed of in the household trash following a few steps.

However, there are some medications that are potentially dangerous and should not be disposed of in the household trash. These medicines should be disposed of by flushing them down the toilet if a take-back option is not readily available. A list of these medicines can be found in the table above.

Some of the medicines recommended for disposal by flushing are available as adhesive skin patches. For example, fentanyl patches are used to treat patients in severe pain by releasing a continuous amount of drug from the patch over three days. Even a used patch that has been worn for three days still contains enough fentanyl to harm or cause death in a child, pet, or another household member. FDA recommends disposing of used patches immediately after taking them off of the skin. Fold the patch in half so that the sticky sides meet, and then flush it down the toilet. Used or unneeded fentanyl patches should NOT be placed in the household trash where children or pets can find them. You can read more about disposing of fentanyl patches in the product Medication Guide.

Some opioid products with uncommon dosage forms (e.g., sprays, lozenges) have product-specific disposal instructions. Review the instructions that came with your prescription, or contact your health care professional (e.g., pharmacist, doctor) about how to properly dispose these medicines.

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Can unused/unexpired medications be donated?
The answer to this question depends on the state in which you live. There are some resources onlinedisclaimer icon that may help you determine whether pharmaceutical donation and reuse programs exist in your state. It should be noted that most state programs do not accept controlled substances.

How do I dispose of dietary supplements and over the counter (OTC) drugs?
Dietary supplements and OTC drugs should be disposed of using a medicine take-back option or by following the directions above for disposal in the household trash.

Mix them (do not crush tablets or capsules) with an unpalatable substance such as dirt, cat litter, or used coffee grounds;
Place the mixture in a container such as a sealed plastic bag and
Throw the container in your household trash.
Does FDA have a pamphlet on drug disposal I can print and hand out?
Yes, please see our Consumer Update: How to Dispose of Unused Medicines.

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Additional Information

FDA Voice Blog: National Drug Take Back Day: A Great Time to Dispose of Prescription Medications Cluttering Your Cabinets
Safe medicine disposal options, a CDER Conversation with Douglas Throckmorton, M.D.
Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel
Paper on the Risks Associated with the Environmental Release of Pharmaceuticals on the U.S. Food and Drug Administration “Flush List”
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